Montana Medicaid Provider Information
WHAT'S NEW ON THE SITE THIS WEEK
Adjustment for Claims Using
Multiple Conversion Factors
An issue was identified related to the implementation of the multiple
conversion factors. Some claims for dates of service between May 1 and
June 30, 2008, that were adjudicated between June 30 and July 6, were
paid at $0.00.
Claims affected:
- Dates of service: May 1, 2008, to June 30, 2008
- Dates of payment: July 1, 2008, to present
- Provider types 06, 07, 08, 10, 17, 21, 22, 42, 45 and 58 — RBRVS providers for Allied and Mental Health
We have corrected the problem and are currently working on an estimate of the impact and an adjustment to correct the situation. This adjustment is planned for Wednesday, July 9.
Holiday ESOR Schedule
Due to the Fourth of July holiday,
Electronic Statements of Remittance (ESORs) will be posted to the website
on Monday afternoon, July 7, or Tuesday morning, July 8.
Transferring Credit Balances
Now that claims are being processed with either National Provider Identifier
(NPI) or atypical provider identifier (API), any activity on your previous
legacy provider number may result in that number moving into a credit
balance. Your legacy number may move in and out of a credit balance depending
on adjustments completed to claims originally billed with the legacy number.
ACS has started moving the credit balance amounts from your legacy number to the NPI/API and will continue to do so until all currently enrolled providers are no longer in a credit balance. This process will take a significant amount of time due to the number of providers involved. If you wish to have your credit balance moved more quickly, please contact Provider Relations and ask to have your credit balance moved to your NPI/API. You will need to indicate the legacy number from which you wish the credit moved and the NPI and taxonomy or API to which you wish the credit moved. These transactions are conducted as gross adjustments and cannot be attributed to any individual client.
When the credit is satisfied, those claims that appeared in the credit balance section of your remittance advice will move into the paid section and can be posted at that time.
Mass Adjustment Issue
On remittance advices dated June 16, 2008, providers may
have seen a credit amount for the denied professional crossover claims
that appeared on previous remittance advices with a reimbursement amount
for the denied claim. There was no reimbursement for the original claim
although a payment amount appeared on the remittance advice. However,
when a mass adjustment was completed to correct a pricing error, the denied
claims were inadvertently included, the amount indicated as a payment
on the denied claims was credited, and the repayment side of the adjustment
was denied. Gross repayment adjustments will be completed in the near
future to repay the inappropriate credit amounts.
Provider File Updates
Providers who have already completed their reenrollment
with Montana's Healthcare Programs in conjunction with the implementation
of NPI do not need to complete a new enrollment if their information changes.
If a reenrolled provider needs to update their provider file (i.e., change
of practice location, billing address, tax information, etc.), they should
mail the new information to Provider Relations, P.O. Box 4936, Helena,
MT 59604 or fax to (406) 442-4402, Attention: Provider File Updates. Health
care providers who have not yet reenrolled with their NPI, or atypical
providers for a new proprietary ID, should so so immediately.
Mass Adjustment for Physician-Administered
Drugs Requiring NDC
Effective April 1, 2008, the National Drug Code (NDC)
is required to be billed in addition to the procedure code for certain
physician-administered drugs. A mass adjustment will be completed soon
for claims with dates of service back to April 1, 2008, containing procedure
codes for these drugs.
The adjustment will take back monies for the following types of claims:
- Those that required but did not include the appropriate NDC
- Those in which the NDC units or the units qualifier are not present
- Those in which the NDC or units qualifier are invalid
When the adjustment date has been scheduled, a notice will appear here on www.mtmedicaid.org.
Please see the provider notice dated April 10, 2008, for additional information related to the NDC requirement.
NPI Reenrollment and Billing National Drug Code Billing Instructions NPI and Taxonomy Electronic Claim
Instructions NPI and Taxonomy Paper Claim Instructions |
NPI Required for Eligibility
Verification
Providers
must use their NPI when inquiring about client eligibility using FAXBack,
the Automated Voice Response System (AVRS), or the web portal. If you
are not yet enrolled with your NPI, please call Provider Relations at
1-800-624-3958.
AVRS/FaxBack Functionality
Enhanced
AVRS/FaxBack has been enhanced to allow providers with multiple enrollments
and different fax numbers for one NPI to verify eligibility. Providers
can also complete eligibility inquiries on the MATH
web portal. If you have any questions, please contact ACS Provider
Relations at 1-800-624-3958.
Institutional Providers Must Use NPI to
Check Eligibility on the Web Portal After January 1, 2008
All old institutional provider numbers will no longer be valid to check
eligibility. These numbers can still be used to check claim status. If
providers do not see their NPI numbers in their drop-down box on the web
portal, they will need to e-mail the submitter number and NPI numbers
to MTPRHelpdesk@acs-inc.com.
Attention New Providers
If you are enrolling for the first time in Montana’s
Healthcare Programs, which include Medicaid, Children’s Health Insurance
Program (CHIP) and Mental Health Services Plan (MHSP), please note the
following.
This enrollment will not be effective to use for billing until October 1, 2007. Services provided prior to October 1 can be billed after October 1. When completing the web enrollment, the effective date of your enrollment is the date you indicate on the enrollment that you first provided services to a Montana's Healthcare Program client.
If you must bill for services prior to October 1, complete and submit the web enrollment and contact Provider Relations at 1-800-624-3958.
Online Reenrollment for NPI Now Available
On-line
reenrollment is now available through Montana Access to Health.
As of March 2, only providers without Internet access will be allowed
to complete a paper application
NPI Paper Reenrollment Form Now Available
The new paper form is available for current providers to begin the reenrollment
process to capture NPI numbers and update information within the provider
system. This reenrollment form can be downloaded at Existing
Provider Reenrollment for Participation On or After October 1, 2007.
Provider Reenrollment for NPI
Effective February 1, 2007, providers
began the reenrollment process by downloading the revised paper enrollment
forms, completing them and mailing them to ACS. Reenrollment utilizing
the web became available March 1, 2007. Institutional providers must ensure
that reenrollment is completed prior to January 1, 2008, and professional
providers prior to March 1, 2008, to continue to be reimbursed by Medicaid.
Only providers that do not have access to the Internet may use the paper
enrollment option after March 1, 2007.
Medicare Part D Prescription Drug Benefit News
Introduction to Medicare Part D Drug BenefitsNeed help with picking the right Part D plan for you or your client?
- State Health Insurance Assistance Program (SHIP) 1-800-551-3191 or visit their Website at http://www.dphhs.mt.gov/sltc/services/aging/ship.shtml
- 1-800-MEDICARE (1-800-633-4227) or Medicare.gov
Stand-Alone Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries in Montana
The WellPoint Point of Sale system for dual-eligible Medicare and Medicaid eligible individuals:
- Point of Sale Facilitated Enrollment of Dual Beneficiaries for Pharmacists
- Point of Sale Facilitated Enrollment of Dual Beneficiaries Tip Sheet
Learn About the Medicare Prescription Drug Plan:
- Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare and Medicaid
- Choosing a Medicare Drug Plan for People with Medicare and Medicaid
- People with Medicare and Medicaid: Medicare will enroll you in a plan automatically. How do you find out which plan?
- Request for Prescription Information or Change. This is a standard form for exceptions or prior authorizations.
Medicaid Program Information Handbook insert. Learn more about Medicaid coverage of prescription drugs for clients who are dual eligible for both Medicare and Medicaid.
Pharmacy
Tamper-Resistant
Prescription Pad Vendors
Get the Most Recent Montana
Medicaid Preferred Drug Information!
Visit the Pharmacy Provider page for a list of preferred drugs and upcoming
Montana Medicaid and Medicaid Mental Health Drug Use Review Board/Formulary
Committee Meetings. (Updated 07/01/08)
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.
Website Tips
For tips on using this website or to download frequently requested resources
(such as how to verify client eligibility, Medicaid covered services,
important contacts, and more), select Website
Tips or Medicaid Information from the menu on the left.
Do you have Adobe Reader?
Most documents on this website require Adobe Acrobat
Reader. Click below to download Adobe Reader for free.
